Search

Neighborhood socioeconomic status (SES) and greenspace can affect respiratory health. However, it is unclear whether effects of neighborhood SES and greenspace on respiratory health still exist regardless of temperature variations. This paper conducted a two-stage, age-stratified case time-series study. The first goal is to examine the associations between two temperature metrics (daily mean temperature [DMT] and diurnal temperature range [DTR]) and respiratory emergency department (ED) visits among four age groups in New York City. The second goal is to evaluate whether neighborhood SES and greenspace would be determinants of respiratory ED visits independent from temperature varying factors. A distributed lag nonlinear model was applied on ED data from 135 zip codes (October 2016 - February 2020). Our first-stage analysis indicated that older adults aged 65+ had higher risk of ED visits (RR=2.78, 95% eCI: 2.41, 3.22; with 7 days of lag) on days with low DMT (-10 °C), followed by adults aged 18-64 (RR=2.48, 95% eCI: 2.32, 2.65), children and youth aged 5-17 (RR=1.38, 95% eCI: 1.24, 1.53), and young children aged 0-4 (RR=1.04, 95% eCI: 0.96, 1.13). However, no excess respiratory ED visits were observed on days with high DMT (30 °C). Higher DTR was associated with higher risk, with children and youth more susceptible when DTR was high (DTR 20 °C; RR=5.70, 95% eCI: 3.42, 9.49; with 7 days of lag). The second-stage analysis indicated neighborhood SES and greenspace had significant associations with respiratory ED visits regardless of temperature variations. Specifically, Higher income and greenspace exposure were negatively associated with ED visits among all age groups. Neighborhood SES and greenspace could affect respiratory morbidity regardless of weather conditions. Daily temperature variations accelerated the short-term risk among population subgroups under different weather conditions (e.g., higher risk of days with low DMT among older adults, higher risk of days with high DTR among children and youth aged 5-17), which could create co-effects with neighborhood SES and greenspace on respiratory health. • Respiratory ED visit was significantly associated with both DMT and DTR. • Older adults more vulnerable to low DMT (RR=2.78, 95% eCI: 2.41, 3.22). • Youth aged 5-17 more vulnerable to high DTR (RR=5.70, 95% eCI: 3.42, 9.49). • SES and greenspace associated with respiratory ED visit regardless of temperature. • Intracity examination of impacts of DMT and DTR on health allows local actions. [ABSTRACT FROM AUTHOR]

In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40–75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation. • Novel health poverty measures applied to T2DM in Malaysia using early mortality risk. • Administrative dataset comprising 1M adults combined with death records and SES. • Male gender, older age and area deprivation drive health poverty. • Nighttime luminosity reveals regional patterns in health poverty. • Combining luminosity data and medical datasets enhances risk stratification in LMICs. [ABSTRACT FROM AUTHOR]

The Delta-Omicron wave of the COVID-19 pandemic (Wave 4) in the United States occurred in Fall of 2021 through Spring of 2022. Although vaccinations were widely available, this was the deadliest period to date in the U.S., and the toll was especially high in rural areas, exacerbating an existing rural mortality penalty. This paper uses county-level multilevel regression models and publicly available data for 47 U.S. states and the District of Columbia. We describe differences in COVID-19 case and mortality rates across the rural-urban continuum during Wave 4 of the COVID-19 pandemic. Using a progressive modeling approach, we evaluate the relative contribution of a range of explanatory factors for the rural disadvantage we observe, including: pre-pandemic population health composition, vaccination rates, political partisanship, socioeconomic composition, access to broadband internet rate, and primary care physicians per capita. Results show that rural counties had higher observed burdens of cases and deaths in Wave 4 compared to more urban counties. The most remote rural counties had Wave 4 COVID-19 mortality rates 52% higher than the most urban counties. Older age composition, worse pre-pandemic population health, lower vaccination rates, higher share of votes cast for Donald Trump in the 2020 Presidential election, and lower socioeconomic composition completely explained the rural disadvantage in reported COVID-19 case rates in Wave 4, and accounting for these factors reversed the observed rural disadvantage in COVID-19 mortality. In models of mortality rate, Trump vote share had the largest effect size, followed by the percentage of the population age 50 or older, the poverty rate, the pre-pandemic mortality rate, the share of residents with a 4-year college degree, and the vaccination rate. These findings add to a growing literature describing the disproportionate toll of the COVID-19 pandemic on rural America, highlighting the combined effect of multiple sources of rural disadvantage. • Rural counties had higher case and death rates in the Delta-Omicron wave. • Rural counties had up to 51% more deaths per capita than the most urban counties. • Age, health, and SES composition partially explained the rural disadvantage. • Vaccination and Trump vote share were separate factors in the rural disadvantage. • Multiple sources of disadvantage combined in rural areas to produce poor outcomes. [ABSTRACT FROM AUTHOR]

The study of spatial accessibility to healthcare services is key to health policy (Pförtner et al., 2019; Vergier et al., 2017). Terms such as 'rurality' or 'medical desertification' were employed to stress the relevance of the topic. Within the existing literature, there is little (if any) concern with the legitimacy of the existing ways to measure inequality. Expert systems were assumed to be in place, and discrepancies or consistency with existing regulations or to views of relevant stakeholders were not considered. This paper discusses spatial accessibility of medical services in three distinct approaches: normative, that is following what national regulations consider as standard; relative, that is what statistical approaches reveal; consensual, which adjusts the indexes based on representations of stakeholders. The three approaches are compared for the case of Romania, an EU country with low population density, ideal to inspect geographical discrepancies. For the relative and the consensual approach, population is adjusted according to different demand expressed by age groups, and also including population and providers from the nearby localities. The normative approach follows official regulations. The refinements in the consensual model are based on survey data from stakeholders and consider distances to neighbouring localities and adjustments according to the age structure of the population in the catchment area. The results reveal high consistency between the consensual and the relative approach. Both are more permissive with respect to detecting medical desertification as compared to the normative approach but prove to be more effective in directing policy when resources are scarce. The normative approach, however, is relevant in depicting the state of the system as contrasted to a desired standard. The relative approach also overlaps with the consensual one. Therefore, to fully characterize spatial accessibility to general practitioners (GPs) and pharmacies, one needs to consider at least the normative and the relative approaches. • Different measurements of spatial access to healthcare overlap only partly. • The relative approach proves its legitimacy. • Relative and consensual approaches better grasp areas under risk. • Normative approaches are more effective to compare to a desired standard. • A multifaceted approach to spatial accessibility is recommended. [ABSTRACT FROM AUTHOR]

While the overall impact of the COVID-19 pandemic on U.S. population health has been devastating, it has not affected everyone equally. The risks of hospitalization and death from the disease are relatively low for the population as a whole, but much higher for specific subpopulations defined by age, health status, and race or ethnicity. The extent to which Americans perceive these disparities is an open question, with potentially important political implications. Recognition of unequal impacts may prime concerns about justice and fairness, making Americans more concerned and willing to support government intervention. On the other hand, belief that the pandemic primarily threatens "other people" or out-groups may reduce, rather than increase, a person's concern. Partisanship and media consumption habits are also likely to play a role in these perceptions, as they do in most issues related to COVID-19. In this paper, we use original survey data from the Cooperative Election Study (N = 1000) to explore Americans' perceptions of which groups are most harmed by the pandemic, the demographic and political determinants of these perceptions, and the relationship of these perceptions with their opinions about COVID-related mitigation policy. We find that, on average, people perceived accurately that certain groups (e.g., Black Americans, older people) were more affected, but these group perceptions varied by demographic and political characteristics of respondents. We find, in contrast with recent experimental evidence, that the perception that populations of color were harmed was associated with more support for pandemic mitigation strategies. More research should investigate the relationships among pandemic politics and the racial dynamics of the target populations most affected. • In fall 2020, survey participants recognized groups harmed by COVID based on age. • They had lower recognition of racial groups harmed, lowest for Native Americans. • Perceptions of groups harmed varies by information exposure and politics. • Perceiving group disparities was associated with more support for pandemic policy. • The racial dynamics surrounding the politics of COVID-19 requires more attention. [ABSTRACT FROM AUTHOR]

While China's economy has grown rapidly in recent decades, urban-rural inequalities in mental health have persisted, and depression is more prevalent among rural women. Using a nationally-representative survey data in China, this paper investigates the impact of women's off-farm employment on their depressive symptoms. Results from instrumental variable and individual fixed effects estimation show that women's participation in off-farm employment leads to a significant reduction in depressive symptoms. We further take into account the confounding effects of working conditions, and the main results are robust. Moreover, off-farm employment enhances women's mental health mainly through pathways including increased absolute income, higher self-perceived relative income, more frequent healthy behaviors, increased likelihood of health investment, and obtaining more formal social support. Further evidence suggests that the depression-reducing effect of off-farm employment is more effective for those with more severe depressive symptoms, middle-aged and elderly persons, and women with lower body mass index. The findings have important implications for preventing depressive disorders and improving mental health in China and other developing countries. • We investigate the impact of women's off-farm employment on their depressive symptoms in rural China. • Women's participation in off-farm employment leads to a significant reduction in depressive symptoms. • Formal social supports derived from workplace are important mechanisms by which employment affects depressive symptoms. • The depression-reducing effect is more effective for women with more severe symptoms and middle-aged and elderly persons. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has affected countries and regions to varying degrees. In this paper, I examine the socioeconomic determinants of Covid-19 mortality and study whether vaccinations have affected the relationship between those determinants and Covid-19 mortality rates across local areas in England. I use monthly data for 6791 Middle Layer Super Output Areas for the period from March 2020 to April 2021 and estimate a spatial correlations model with local authority and time fixed effects. To study whether vaccinations have affected the relationship between socioeconomic determinants and Covid-19 mortality, I extend the model to include interactions between socioeconomic variables and the lagged cumulative vaccination rate. I find that Covid-19 mortality is higher in areas that have an older population, a larger share of Asian population, higher population density, lower income, poorer pre-existing health and a larger share of employment in health and social care occupations. Vaccinations have weakened the links between mortality and these socioeconomic characteristics. These findings highlight the importance of making vaccines widely available and encouraging take-up, to reduce inequality in Covid-19 mortality across socioeconomic groups. • Covid-19 mortality is higher in areas of England with an older population. • Mortality is higher in areas with a larger share of Asian population. • Mortality is higher in areas with higher population density and lower income. • Mortality is higher in areas with poorer health and more health workers. • Vaccines weaken the links between mortality and socioeconomic characteristics. [ABSTRACT FROM AUTHOR]

This study examined the context and drivers of HIV risk and vulnerability among male partners of female sex workers in Kampala, Uganda, using an "intersectional risk environment" framework. This research reports on findings from an ethnographic study (2016–2019) of men in one informal settlement in Kabalagala Parish in Kampala. This research included long-term participant observation in and around the study community. Thematic analysis was used to assess aspects of the risk environment and how it influences HIV/AIDS among male partners of female sex workers. The informal settlement context where sex work takes place is conceptualized here as a "risk environment," or a social-physical space in which risk and harm are produced (Rhodes, 2002). Risk is situated within a broader social and political structure that constrains choices and facilitates HIV risk, particularly for young, low-income men facing matrices of domination on the basis of age, gender, residence, and income. These intersectionalities guide experiences of HIV vulnerability in the risk environment, including physical, social, economic, and policy risks. This includes physical risks (population density, bar density), social risks (sex work, bar groups), economic risks (informal and low wage work), and political risks (anti-poverty laws and legislation, urban policy). These findings highlight how an intersectional risk environment is differentially experienced by young, low-income men to produce unequal HIV/AIDS outcomes. This research fills a gap in the literature on the context of HIV/AIDS among men, particularly high-risk men like male partners of female sex workers. Using this framework will improve understandings of HIV outcomes among male partners of female sex workers and will facilitate context-specific and adapted structural interventions for HIV/AIDS prevention and treatment. • Male partners of female sex workers are key in Uganda's HIV epidemic. • This paper uses an intersectional risk environment to understand HIV risk. • The risk environment includes intimate partnerships and men's bar groups. • Young men face additional risks due to unemployment and alcohol use. • Young men face higher rates of arrest due to over-policing in the community. [ABSTRACT FROM AUTHOR]